Clinical and Dermoscopic Characterization of Mixed-Type Basal Cell Carcinoma
Keywords:
mixed-type BCC, dermoscopy, Basal cell carcinoma (BCC)Abstract
Introduction: Basal cell carcinoma (BCC) is a malignant skin tumor that originates from epidermal basal cells or the outer root sheath of hair follicles. Identifying histopathological subtypes is crucial to guiding treatment and patient follow-up. While dermoscopic features associated with histopathological subtypes have been studied, the changes in dermoscopic findings in mixed-type BCC remain unclear.
Objectives: This study aimed to analyze the demographic characteristics of patients diagnosed with single and mixed-type BCC and to investigate the correlation between clinical and dermoscopic findings and histopathological subtypes.
Results: A total of 186 BCC lesions from 157 patients were analyzed. The mean patient age was 68.8±12.7 years (range: 30–94). The most common lesion location was the head and neck region (74.7%). The distribution of histopathological subtypes was as follows: nodular (42.5%), mixed-type (37.6%), superficial (12.4%), basosquamous (3.2%), infiltrative (2.7%), micronodular (1.1%), and fibroepithelial (0.5%). The most frequent mixed-type BCC combinations were nodular-infiltrative (32.9%), nodular-superficial (31.4%), and nodular-micronodular (12.9%).
Short fine telangiectasia, yellow-white structureless areas, scales, and rosette structures were more frequent in mixed-type BCC. Corkscrew vessel patterns were more common in single-type lesions. The presence of a superficial component in mixed-type BCC was associated with wheel-like structures, while infiltrative components correlated with dotted and glomerular vessel patterns, and basosquamous components were linked to arborizing vessel patterns. Additionally, arborizing vessel patterns (P=0.019) and dotted vessel patterns (P=0.025) were associated with high-risk subtypes in mixed-type BCC.
Conclusion: Our study suggests that dermoscopic findings may serve as a guide to recognizing mixed-type BCC lesions, distinguishing between subtype components, and assisting in treatment decision-making based on these observations.
References
Lomas A, Leonardi-Bee J, Bath-Hextall F. A systematic review of worldwide incidence of nonmelanoma skin cancer. Br J Dermatol. 2012;166(5):1069-1080. DOI:10.1111/j.1365-2133.2012.10830.x
Youssef KK, Van Keymeulen A, Lapouge G, et al. Identification of the cell lineage at the origin of basal cell carcinoma. Nat Cell Biol. 2010;12(3):299-305. DOI:10.1038/ncb2031
McDaniel B, Badri T, Steele RB. Basal Cell Carcinoma. StatPearls. Treasure Island (FL)2025.
Elder DE, et al. WHO classification of skin tumours.2018.
Schmults CD, Blitzblau R, Aasi SZ, et al. Basal Cell Skin Cancer, Version 2.2024, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2023;21(11):1181-1203. DOI:10.6004/jnccn.2023.0056
Niculet E, Craescu M, Rebegea L, et al. Basal cell carcinoma: Comprehensive clinical and histopathological aspects, novel imaging tools and therapeutic approaches (Review). Exp Ther Med. 2022;23(1):60. DOI:10.3892/etm.2021.10982
Kaur P, Mulvaney M, Carlson JA. Basal cell carcinoma progression correlates with host immune response and stromal alterations: a histologic analysis. Am J Dermatopathol. 2006;28(4):293-307. DOI:10.1097/00000372-200608000-00002
Bartoš V, Kullová M. Basal cell carcinoma of the skin with mixed histomorphology: a comparative study. Bazocelulárny karcinóm kože so zmiešaným histomorfologickým obrazom: porovnávacia štúdia. Cesk Patol. 2016;52(4):222-226.
Reiter O, Mimouni I, Gdalevich M, et al. The diagnostic accuracy of dermoscopy for basal cell carcinoma: A systematic review and meta-analysis. J Am Acad Dermatol. 2019;80(5):1380-1388. DOI:10.1016/j.jaad.2018.12.026
WHO Classification of Skin Tumours. https://publications.iarc.who.int/Book-And-Report-Series/Who-Classification-Of-Tumours/WHO-Classification-Of-Skin-Tumours-2018
Hernández-Ibáñez C, Blazquez-Sánchez N, Aguilar-Bernier M, Fúnez-Liébana R, Rivas-Ruiz F, de Troya-Martín M. Usefulness of High-Frequency Ultrasound in the Classification of Histologic Subtypes of Primary Basal Cell Carcinoma. Utilidad de la ecografía cutánea en la clasificación de subtipos de los carcinomas basocelulares primarios. Actas Dermosifiliogr. 2017;108(1):42-51. DOI:10.1016/j.ad.2016.08.002
Ghanadan A, Abbasi A, Rabet M, Abdollahi P, Abbasi M. Characteristics of Mixed Type Basal Cell Carcinoma in Comparison to Other BCC Subtypes. Indian J Dermatol. 2014;59(1):56-59. DOI:10.4103/0019-5154.123496
Lallas A, Apalla Z, Argenziano G, et al. The dermatoscopic universe of basal cell carcinoma. Dermatol Pract Concept. 2014;4(3):11-24. Published 2014 Jul 31. DOI:10.5826/dpc.0403a02
Lallas A, Tzellos T, Kyrgidis A, et al. Accuracy of dermoscopic criteria for discriminating superficial from other subtypes of basal cell carcinoma. J Am Acad Dermatol. 2014;70(2):303-311. DOI:10.1016/j.jaad.2013.10.003
Emiroglu N, Cengiz FP, Kemeriz F. The relation between dermoscopy and histopathology of basal cell carcinoma. An Bras Dermatol. 2015;90(3):351-356. DOI:10.1590/abd1806-4841.20153446
Gürsel Ürün Y, Fiçicioğlu S, Ürün M, Can N. Clinical, Dermoscopic and Histopathological Evaluation of Basal Cell Carcinoma. Dermatol Pract Concept. 2023;13(1):e2023004. Published 2023 Jan 1. DOI:10.5826/dpc.1301a4
Fikrle T, Divisova B, Pizinger K. Clinical-Dermoscopic-Histopathological Correlations in Collision Skin Tumours. Indian J Dermatol. 2021;66(6):577-582. DOI:10.4103/ijd.ijd_938_20
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Fethi Zaid, Kerem Balan, Gonca Elcin, Ozay Gokoz, Duygu Gulseren
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Dermatology Practical & Conceptual applies a Creative Commons Attribution License (CCAL) to all works we publish (http://creativecommons.org/licenses/by-nc/4.0/). Authors retain the copyright for their published work.
How to Cite
Share
